Individual
MATILDA BESONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
616 19TH ST, COLUMBUS, GA 31901-1528
(706) 494-4262
Mailing address
4095 SOARING DR, DOUGLASVILLE, GA 30135-7459
(205) 317-6175
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN106732
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
244006770A
—
GA
05
—
244006770B
—
GA
Enumeration date
04/26/2007
Last updated
10/06/2007
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